The second phase of the health insurance system for civil servants and pensioners (Medisep) will offer increased insurance coverage, a larger and more comprehensive package of procedures and improved coverage of catastrophic diseases.
The State Cabinet, which met here on Wednesday, approved phase 2 Medisep, which was redesigned according to the recommendations of the expert committee created by the government.
If the basic insurance coverage in the first phase of Medisep was £ 3 lakh, in the second phase the basic coverage increases to 5 lakh.
In principle, the Cabinet also approved the recommendations that Medisep be extended to employees and pensioners in companies, corporations, autonomous and legal authorities and cooperation industry, where health insurance coverage could be offered by private insurance companies.
In a state in which catastrophic expenditure on the health of poor families is expected that this extension of state insurance coverage to a piece of middle class is expected to reduce the health spending outside the pocket.
Nursing packages
Increased phase 2 scheme means that premium and healing packages will also increase. However, if the system is extended to multiple population categories, this increase in the overall risk fund can still help maintain premium at a reasonable level.
Medisep, which was originally launched in July 2022, offered basic insurance coverage of 3 GBP Lakh for a monthly bonus of 500 GBP. It included more than 30 individuals of the lamps, including about 5.45 Lakh government employees, 5.89 Lakh pensioners and their dependent people. However, there was gross weather due to absence in the field of specialized hospitals in the private sector, which claimed that treatment rates for various medical procedures were “impractical and unrealistic”.
The expert committee set up the government for the purpose of reworking the system, recommended that this system be reworked on the basis of a package of health benefits (HBP) 2022, the latest and scientific package of health costs formulated by the National Health Office.
2,100 procedures
The basic treatment package will offer more than 2,100 treatment procedures in 41 specialties. Surgical procedures such as hip and joint replacement will be included under the basic package.
The catastrophic health package within Medisep 2 will have 10 treatments, including surgery operations. The insurance company will be asked to set aside the corpus fund for two years, for a melody of 40 crore.
Initially, continuous daily care procedures such as dialysis or chemotherapy will be returned, for which a one -time registration can be carried out on the insurance portal. Medical and surgical packages can be clubed and approval. The expenditure for the presentation will be returned for three days and expenditure after hospitalization for five days.
The ceiling of rent in the hospital room for private hospitals will increase to 5,000 GBP per day, while the ceiling of the rent for payment in government hospitals was set at 2,000 GBP per day.
The government decided to include only the insurance companies of the public sector, which were found technically qualified during the offer procedure for Medisep 1, to the second phase of the selection procedure.
According to Medisep 2, the definition of “emergency procedures” (road traffic accidents, heart attack and stroke) for which the payment may be offered, although treatment in hospitals that was not entertained includes another 10 conditions. A three -stage remedial mechanism in the district/state level and the appellate body will be established.
Published – 6. August 2025 20:19
